KITTSON MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- KITTSON MEMORIAL HOSPITAL ASSOCIATION (EIN 41-0724034)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-09
- IRS object ID
- 201932219349301563
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-09T17:29:51-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410724034 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KITT | BusinessNameControlTxt |
| Phone | 2188433612 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 700 | AddressLine1Txt |
| City | HALLOCK | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56728 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENI SCHWENZFEIER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2188433612 | PhoneNum |
| Signature | 2019-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN ENGEBRETSON | PreparerPersonNm |
| PTIN | P01585625 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-09 | IPDt |
| IP Tm | 10:03:17 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 3018D2C7A8EF8E88940F980D8F52F9F97466C021 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9C1DED54EE6A56468881F41BE7A7DD662CF8FCB7 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JENI SCHWENZFEIER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 S BIRCH AVE | AddressLine1Txt |
| City | HALLOCK | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56728 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,330,546 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KITTSONHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1919 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | KITTSON ENSURES THAT NORTHWESTERN MINNESOTA RESIDENTS HAVE ACCESS TO HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 259 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $11,767 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$6,998 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $261,096 | PYContributionsGrantsAmt |
| CY Contributions Grants | $131,285 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,498,564 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,120,138 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,256 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,834 | CYInvestmentIncomeAmt |
| PY Other Revenue | $86,962 | PYOtherRevenueAmt |
| CY Other Revenue | $53,843 | CYOtherRevenueAmt |
| PY Total Revenue | $14,861,878 | PYTotalRevenueAmt |
| CY Total Revenue | $15,307,100 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $16,145 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,116 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,106,213 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,383,804 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $758 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,639,201 | PYOtherExpensesAmt |
| CY Other Expenses | $6,151,004 | CYOtherExpensesAmt |
| PY Total Expenses | $14,761,559 | PYTotalExpensesAmt |
| CY Total Expenses | $15,540,924 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $100,319 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$233,824 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,718,845 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,848,483 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,171,817 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,491,135 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,547,028 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,357,348 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CARING FOR FRIENDS AND NEIGHBORS, KITTSON MEMORIAL HEALTHCARE CENTER PROVIDES AND COOPERATES WITH OTHERS TO ENSURE THAT RESIDENTS HAVE ACCESS TO SERVICES NECESSARY TO MAINTAIN THEIR HEALTH AND WELL-BEING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,429,866 | ExpenseAmt |
| Grant | $6,116 | GrantAmt |
| Revenue | $15,120,138 | RevenueAmt |
| Desc | KITTSON MEMORIAL HEALTHCARE CENTER (KMHC) PROVIDES SERVICE TO EMERGENCY, ACUTE, AND CLINIC PATIENTS. ALL PATIENTS ARE TREATED IN AN EMERGENCY SETTING REGARDLESS OF ABILITY TO PAY OR FINANCIAL CLASS STATUS. KMHC HOME HEALTH PROVIDES MEDICAL AND PERSONAL ASSISTANCE TO THOSE PATIENTS WHO ARE HOME BOUND. THIS VALUED SERVICE PROVIDES AREA RESIDENTS WITH THE ASSISTANCE THEY NEED TO LIVE INDEPENDENTLY WHETHER IT BE HOUSEKEEPING SERVICES, MEDICATION DISPENSION, OR DAILY DRESSING CHANGES. KMHC'S ASSISTED LIVING COMPLEX PROVIDES THOSE AREA RESIDENTS WITH OPTIONS TO ASSIST IN THEIR TRANSGRESSION FROM LIVING INDEPENDENTLY TO CONGREGATE DINING WITH OTHER ASSISTED LIVING RESIDENTS, MEDICATION DISPENSION ASSISTANCE, AND ACCESS TO ACTIVITIES IN THE NURSING HOME. RESIDENTS ARE ALSO ABLE TO "COME AND GO" AS THEY PLEASE WITH ACCESS TO THEIR OWN TRANSPORTATION OR TRANSPORTATION MAY BE ARRANGED. | Desc |
| Total Program Service Expenses | $11,429,866 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 259 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENI SCHWENZFEIER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2188433612 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 SOUTH BIRCH AVENUE | AddressLine1Txt |
| City | HALLOCK | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56728 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JON BLOMQUIST THROUGH 318 | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $700 | $0 | $0 | |
| STEVE GROSZ THROUGH 718 | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $2,370 | $0 | $0 | |
| LEE PEMBERTON THROUGH 318 | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $16,294 | $0 | $0 | |
| TODD JOHNSON THROUGH 718 | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $1,656 | $0 | $0 | |
| CHARLIE BERNSTROM | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JANELLE CRAIGMILE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $898 | $0 | $0 | ||
| CEDRIC GUSTAFSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BOB JASZCZAK | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR ROLAND LARTER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $600 | $0 | $0 | ||
| RICHARD MORTENSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $700 | $0 | $0 | ||
| SANDRA NELSON THROUGH 718 | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARLENE PEARSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SANDY WILSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEREK HOLT | |||||||
| CFO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| ASHLEY RIVERA | |||||||
| CEO/CFO | 40.00 | Yes (X) | $132,032 | $0 | $7,900 | ||
| PAUL ANDERSON THROUGH 318 | |||||||
| PHYSICIANS ASSISTANT | 32.00 | $154,076 | $0 | $14,556 | Yes (X) | ||
| JULIE JOHNSON | |||||||
| NURSE PRACTITIONER | 32.00 | $131,823 | $0 | $2,500 | Yes (X) | ||
| THOMAS LOHSTRETER THROUGH 418 | |||||||
| MEDICAL DOCTOR | 40.00 | $423,249 | $0 | $10,318 | Yes (X) | ||
| JAMES SURDY | |||||||
| MEDICAL DOCTOR | 40.00 | $422,706 | $0 | $14,394 | Yes (X) | ||
| KAREN WARNER | |||||||
| PHYSICIANS ASSISTANT | 40.00 | $155,025 | $0 | $1,600 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,442,129 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $51,268 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DIAGNOSTIC MEDICAL SYSTEMS | |||||
| 26273 NETWORK PLACE | CHICAGO | IL | 60673 | CT, MAMMOGRAPHY, MRI, ULTRASOUND | $420,348 |
| ALTRU HEALTH SYSTEM | |||||
| PO BOX 13780 | GRAND FORKS | ND | 58206 | OUTREACH THERAPY | $320,953 |
| AGILITI HEALTH INC | |||||
| PO BOX 851313 | MINNEAPOLIS | MN | 55485 | EQUIPMENT MAINTENANCE | $156,933 |
| HITNER HEATING & COOLING | |||||
| PO BOX 2722 | FARGO | ND | 58108 | EQUIPMENT MAINTENANCE | $149,417 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $18,266 | FundraisingAmt |
| All Other Contributions | $113,019 | AllOtherContributionsAmt |
| Total Contributions | $131,285 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT & RESIDENT SERVICE REVENU | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $15,120,138 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,120,138 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,120,138 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,298 | TotalRevenueColumnAmt |
| Exclusion | $20,298 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,592 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,592 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,592 | TotalRevenueColumnAmt |
| Exclusion | $6,592 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $18,464 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$18,464 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,464 | TotalRevenueColumnAmt |
| Exclusion | -$18,464 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $4,542 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $18,266 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $4,982 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$440 | TotalRevenueColumnAmt |
| Exclusion | -$440 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $277 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $277 | TotalRevenueColumnAmt |
| Exclusion | $277 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| CAFETERIA INCOME | 722210 | $25,117 | $11,767 | $13,350 |
| MISCELLANEOUS | 900099 | $22,118 | $22,118 | |
| FITNESS CENTER INCOME | 713940 | $179 | $179 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $47,414 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,307,100 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,120,138 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $11,767 | UnrelatedBusinessRevenueAmt |
| Exclusion | $43,910 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,116 | TotalAmt |
| Program Services | $6,116 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,638 | TotalAmt |
| Program Services | $75,328 | ProgramServicesAmt |
| Management And General | $301,310 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,419,359 | TotalAmt |
| Program Services | $6,331,030 | ProgramServicesAmt |
| Management And General | $1,088,329 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,232 | TotalAmt |
| Program Services | $116,043 | ProgramServicesAmt |
| Management And General | $29,189 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $917,011 | TotalAmt |
| Program Services | $46,723 | ProgramServicesAmt |
| Management And General | $870,288 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $525,564 | TotalAmt |
| Program Services | $453,010 | ProgramServicesAmt |
| Management And General | $72,554 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,044 | TotalAmt |
| Program Services | $504 | ProgramServicesAmt |
| Management And General | $60,540 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,061 | TotalAmt |
| Management And General | $190,061 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,886,067 | TotalAmt |
| Program Services | $1,658,277 | ProgramServicesAmt |
| Management And General | $227,790 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,627 | TotalAmt |
| Program Services | $876 | ProgramServicesAmt |
| Management And General | $99,751 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $819,739 | TotalAmt |
| Program Services | $560,955 | ProgramServicesAmt |
| Management And General | $258,784 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $379,494 | TotalAmt |
| Program Services | $25,126 | ProgramServicesAmt |
| Management And General | $354,368 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $334,000 | TotalAmt |
| Program Services | $71,206 | ProgramServicesAmt |
| Management And General | $262,794 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,553 | TotalAmt |
| Program Services | $67,863 | ProgramServicesAmt |
| Management And General | $23,690 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,865 | TotalAmt |
| Program Services | $46,722 | ProgramServicesAmt |
| Management And General | $25,143 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,657 | TotalAmt |
| Program Services | $27,487 | ProgramServicesAmt |
| Management And General | $118,170 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $744,114 | TotalAmt |
| Program Services | $744,114 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,908 | TotalAmt |
| Management And General | $99,908 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $545,664 | $545,664 | ||
| BAD DEBT EXPENSE | $359,671 | $359,671 | ||
| FOOD | $220,846 | $211,266 | $9,580 | |
| OTHER EXPENSES | $100,694 | $81,885 | $18,051 | $758 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,540,924 | TotalAmt |
| Program Services | $11,429,866 | ProgramServicesAmt |
| Management And General | $4,110,300 | ManagementAndGeneralAmt |
| Fundraising | $758 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $711 | BOYAmt |
| EOY | $711 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,577,958 | BOYAmt |
| EOY | $2,019,814 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,573,822 | BOYAmt |
| EOY | $1,504,979 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,887 | BOYAmt |
| EOY | $12,241 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,371 | BOYAmt |
| EOY | $194,337 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,686 | BOYAmt |
| EOY | $135,919 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,645,462 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,137,206 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,027,353 | BOYAmt |
| EOY | $3,508,256 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,175,057 | BOYAmt |
| EOY | $1,246,226 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $226,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,718,845 | BOYAmt |
| EOY | $8,848,483 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,399,346 | BOYAmt |
| EOY | $1,583,964 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,586 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,945 | BOYAmt |
| EOY | $6,706 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,036,233 | BOYAmt |
| EOY | $2,724,954 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,707 | BOYAmt |
| EOY | $175,511 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $416,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,171,817 | BOYAmt |
| EOY | $4,491,135 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,547,028 | BOYAmt |
| EOY | $4,306,801 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $547 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $50,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,547,028 | BOYAmt |
| EOY | $4,357,348 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,718,845 | BOYAmt |
| EOY | $8,848,483 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$233,824 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$6,168 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $50,312 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,908 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,908 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION, A PORTION OF WHICH IS SPENT ON LOBBYING ON BEHALF OF ITS MEMBERS. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $10,442 | BeginningBalanceAmt |
| Additions During Year | $11,151 | AdditionsDuringYearAmt |
| Distributions During Year | $14,648 | DistributionsDuringYearAmt |
| Ending Balance | $6,946 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| Contributions | $50,000 | ContributionsAmt |
| Investment Earnings Or Losses | $547 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $50,547 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,985 | OtherCostOrOtherBasisAmt |
| Book Value | $12,985 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,698,405 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,895,644 | DepreciationAmt |
| Book Value | $1,802,761 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $461,150 | OtherCostOrOtherBasisAmt |
| Depreciation | $300,311 | DepreciationAmt |
| Book Value | $160,839 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,354,935 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,941,251 | DepreciationAmt |
| Book Value | $1,413,684 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $117,987 | OtherCostOrOtherBasisAmt |
| Book Value | $117,987 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,508,256 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,952,411 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$359,671 | OtherRevenueAmt |
| Revenue Not Reported | -$359,671 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,312,082 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$4,982 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$4,982 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,307,100 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,186,235 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $4,982 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $4,982 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,181,253 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $359,671 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $359,671 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,540,924 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | A SMALL AUXILIARY OPERATES UNDER THE HOSPITAL'S EIN. |
| PART IV, LINE 2B: | THE CENTER HOLDS FUNDS UNDER AN AGENCY RELATIONSHIP FOR THE RESIDENTS OF THE NURSING FACILITY. |
| PART X, LINE 2: | THE CENTER IS ORGANIZED AS A MINNESOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE CENTER BELIEVES THAT IT IS COMPLIANT WITH ALL IRS TAX REGULATIONS AND AS OF SEPTEMBER 30, 2018 AND 2017 HAS NOT RECORDED LIABILITIES FOR INCOME TAXES. THE CENTER WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF INCURRED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS -359,671. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | GOLF TOURNAMENT EXPENSE -4,982. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | GOLF TOURNAMENT EXPENSE 4,982. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 359,671. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $22,808 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $18,266 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $4,542 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $640 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $1,962 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $1,465 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $915 | FoodAndBeverageEvent1Amt |
| Gross Receipts Total | $22,808 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $18,266 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $4,542 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $640 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $1,962 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $1,465 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $915 | FoodAndBeverageTotalEventsAmt |
| Direct Expense Summary Events | $4,982 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$440 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,706 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,706 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $890,462 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $695,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $195,278 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01260 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $896,168 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $695,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $200,984 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,065,613 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,747,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,318,395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08480 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,065,613 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,747,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,318,395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,961,781 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,442,402 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,519,379 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09780 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $359,671 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,828,124 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,692,718 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$864,594 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 SOUTH BIRCH AVENUE | AddressLine1Txt |
| City | HALLOCK | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56728 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KMHC.NET | WebsiteAddressTxt |
| State License | 371450 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION B, LINE 7D. | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION B, LINE 7D. | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://KITTSONHC.ORG/PREPARE-FOR-YOUR-NEXT-VISIT/#FINANCES | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://KITTSONHC.ORG/PREPARE-FOR-YOUR-NEXT-VISIT/#FINANCES | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://KITTSONHC.ORG/PREPARE-FOR-YOUR-NEXT-VISIT/#FINANCES | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KITTSON MEMORIAL HEALTHCARE CENTER | PART V, SECTION B, LINE 5: IN THE 2015 ASSESSMENT, COMPLETED BY SEPTEMBER 2016, WE REVIEWED OUR ASSESSMENT AND IMPLEMENTATION PLAN FROM 2013 AND REVIEWED THE CURRENT DATA FOR HEALTH TRENDS FOR OUR COUNTY. WE ALSO DID A SELECTED MAILING OF "QUALITY OF LIFE" SURVEYS TO A TARGETED AUDIENCE THROUGHOUT THE COUNTY. THE TARGET LIST OF INDIVIDUALS INCLUDED SCHOOL SUPERINTENDENTS, COUNTY SOCIAL SERVICES STAFF, SENIOR CITIZEN CENTERS AROUND THE COUNTY, THE MAYORS OF ALL THE COMMUNITIES IN THE COUNTY, PUBLIC HEALTH STAFF, AND THE COUNTY ADMINISTRATOR. WE REQUESTED THEIR OPINIONS ON IMPORTANT SERVICES THAT THEY WOULD LIKE TO SEE ADDED TO OUR FACILITY OR MAINTAINED BY OUR FACILITY. |
| KITTSON MEMORIAL HEALTHCARE CENTER | PART V, SECTION B, LINE 7D: HTTPS://WWW.KMHC.NET/COMMUNITY-NEEDS--- EMERGENCY-PREPAREDNESS.HTML |
| KITTSON MEMORIAL HEALTHCARE CENTER | PART V, SECTION B, LINE 11: KITTSON HEALTHCARE CONTINUES TO ADDRESS AND ATTAIN GOALS RELATED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT'S IMPLEMENTATION PLAN. A NEW/REVISED CHNA WILL TAKE PLACE IN CALENDAR YEAR 2019.EMERGENCY ROOM SERVICES HAVE CONTINUED 24 HOURS A DAY AND 7 DAYS A WEEK. SIGNIFICANT PROGRESS HAS BEEN MADE IN SECURING RETAIL PHARMACY IN KITTSON COUNTY, PARTICULARLY IN HALLOCK. IN JULY OF 2019, KITTSON HEALTHCARE WILL BE OPENING A RETAIL PHARMACY AT THEIR HALLOCK LOCATION, WHILE THE LOCAL PHARMACIST IN HALLOCK TRANSITIONS INTO RETIREMENT. KITTSON HEALTHCARE IS ALSO ADDRESSING ADDITIONAL MENTAL HEALTH NEEDS AND IS WORKING WITH NORTHWEST MENTAL HEALTH CENTER TO EXPAND PROVIDER AVAILIBILITY TO RESIDENTS OF KITTSON COUNTY. PUBLIC HEALTH CONTINUES TO IDENTIFY PROGRAMS OF NEED SUCH AS SMOKING CESSATION, OBSESITY, DIABETIC PREVETNTION, ELDERLY WAIVER SERVICES, ETC.KITTSON MEMORIAL STAFF FOLLOW THE AMERICAN CANCER RECOMMENDATIONS FOR CANCER SCREENINGS. WE CONTINUE TO OFFER ENDOSCOPY SERVICES AT OUR FACILITY ONE DAY A MONTH, WITH ADDITIONAL DAYS OPTIONAL DEPENDING ON THE NEED OF OUR RESIDENTS. WE ALSO CONTINUE TO OFFER DIGITAL MAMMOGRAPHY EVERY OTHER WEEK. THESE SERVICES ARE VITALLY IMPORTANT FOR OUR RESIDENTS SO THAT THEY DO NOT HAVE TO DRIVE 45-60 MILES AWAY FOR TESTING. CANCER PREVENTION AND SCREENING INFORMATION IS DISSEMINATED TO COUNTY RESIDENTS THROUGH THE COUNTY FAIR AND ARTICLES IN THE LOCAL NEWSPAPERS.USE OF SEATBELTS IS STRESSED TO ALL AGE GROUPS IN ALL OF THE SCHOOLS WITHIN THE COUNTY. POSTERS ABOUT SEATBELTS ARE DISPLAYED IN CLINIC EXAM ROOMS IN OF OUR CLINICS IN HALLOCK AND KARLSTAD. ONE OF THE COMMUNITY HEALTH NURSES IS TRAINED IN SEAT BELT/CAR SEAT SAFETY FOR NEW PARENTS AND GIVES INSTRUCTIONS AS REQUESTED. ALL OF OUR PREGNANT MOTHERS GIVE BIRTH AT FACILITIES OUTSIDE OF OUR COUNTY, BUT WE PROVIDE THIS SERVICE TO PARENTS WHO ARE FOSTERING CHILDREN, ADOPTING, OR WANT A REVIEW OF CAR SEAT SAFETY.BOTH THE CNHA AND THE IMPLEMENTATION PLAN WERE FORMETLY ADOPTED BY THE BOARD AND APPROVAL IS REFLECTED IN THE MEETING MINUTES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - KITTSON MEMORIAL CLINIC OF KARLSTAD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 ROOSEVELT AVENUE WEST | AddressLine1Txt |
| City | KARLSTAD | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56372 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | TO QUALIFY FOR FINANCIAL ASSISTANCE, AN INDIVIDUAL MUST:(A) RECEIVE MEDICALLY NECESSARY CARE AT THE HOSPITAL;(B) HAVE TOTAL INCOME LESS THAN OR EQUAL TO 200 PERCENT OF FEDERAL POVERTY GUIDELINES;(C) APPLY FOR MEDICAID; AND(D) SUBMIT A COMPLETE COMMUNITY CARE (FINANCIAL ASSISTANCE) APPLICATION, INCLUDING REQUIRED DOCUMENTATION. |
| PART I, LINE 6A: | THE ANNUAL COMMUNITY BENEFIT REPORT IS MADE AVAILABLE UPON REQUEST. |
| PART I, LINE 7: | THE ORGANIZATION USED THE FOLLOWING METHODS TO DETERMINE THE COST AMOUNTS IN PART I, LINE 7:LINES 7A AND 7B - CHARITY CARE AND MEDICAID WERE DERIVED FROM INTERNAL REPORTS. COSTS WERE CALCULATED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 FROM THE IRS.LINES 7E AND 7G - COMMUNITY HEALTH IMPROVEMENT SERVICES AND SUBSIDIZED HEALTH SERVICES AMOUNTS ARE ACTUAL COSTS. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G INCLUDE COSTS AND REVENUES ASSOCIATED WITH HALLOCK RURAL HEALTH CLINIC, KARLSTAD RURAL HEALTH CLINIC, EMERGENCY ROOM SERVICES, AND CARDIAC REHABILIATION SERVICES. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS COLLECTION HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. |
| PART III, LINE 3: | THE ORGANIZATION HAS NOT IDENTIFIED A METHOD TO REASONABLY ESTIMATE THE PORTION OF OUR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | SEE THE "PATIENT AND RESIDENT RECEIVABLES" SECTION IN NOTE 1 (PAGE 8) TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. |
| PART III, LINE 8: | THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 IS DUE TO THE NON-ALLOWABLE/NON-REIMBURASABLE COSTS PER THE MEDICARE COST REPORT AND WOULDN'T NECESSARILY BE CONSIDERED COMMUNITY BENEFIT IN NATURE.THE MEDICARE ALLOWABLE COSTS REPORTED IN PART III, LINE 6 WERE DERIVED USING THE FY 2018 FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | COLLECTION EFFORTS ARE MADE BY CONTACTING THE PATIENT THROUGH WRITTEN CORRESPONDENCE AND PHONE CALLS. IF, THROUGHOUT THESE CONVERSATIONS, THE COLLECTOR AND PATIENT DISCUSS THAT THE PATIENT IS NOT ABLE TO AFFORD PAYMENTS AS REQUIRED BY OUR POLICY, THE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY CARE. AN APPLICATION, PLAIN LANGUAGE SUMMARY, AND FAP ARE SENT TO THE PATIENT TO REVIEW AND COMPLETE. ACCORDING TO FEDERAL POVERTY GUIDELINES, THE PATIENT MAY QUALIFY FOR ALL OR A PERCENT OF CHARGES WRITTEN OFF THEIR ACCOUNT. PATIENTS MUST APPLY FOR MEDICAID PRIOR TO QUALIFYING FOR CHARITY CARE. ADDITIONAL INFORMATION IS OFFERED TO HELP THEM APPLY FOR STATE FUNDED PROGRAMS. |
| PART VI, LINE 2: | PUBLIC HEALTH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS INFORMATION IS THEN SHARED WITH FACILITY MANAGEMENT AND THE BOARD OF DIRECTORS. GOING FORWARD, A CHNA WILL BE CONDUCTED EVERY THREE YEARS TO MAKE THIS ASSESSMENT.IN ADDITION TO CONDUCTING THE CHNA EVERY THREE YEARS, KITTSON INFORMALLY LISTENS TO THE PUBLIC'S REQUEST FOR SERVICES. THROUGH OUR PUBLIC HEALTH AND SCHOOL HEALTH WORK, WE ARE CONTINUALLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY AND MEETING THE NEEDS AT THE TIME. FOR EXAMPLE, KITTSON HELD PUBLIC MEETINGS WITH COUNSELORS WHEN THE COMMUNITY HAD A NEED FOR ADDITIONAL SUPPORT AND INFORMATION REGARDING SUICIDE. |
| PART VI, LINE 3: | IF A PATIENT IS UNABLE TO PAY THEIR BILL, THE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY CARE. AN APPLICATION IS SUBSEQUENTLY SENT TO COMPLETE, ALONG WITH A COPY OF OUR FAP AND PLAIN LANGUAGE SUMMARY (A NOTICE IS INCLUDED IN THEIR MONTHLY STATEMENT TO CONTACT US REGARDING CHARITY CARE IF THEY ARE UNABLE TO PAY THEIR BILL). WE ARE ADDITIONALY ABLE TO PROVIDE PATIENTS WITH CONTACT INFORMATION AT THE COUNTY FOR QUALIFICATION/APPLICATION INFORMATION REGARDING GOVERNMENTAL FINANCIAL ASSISTANCE. INFORMATION REGARDING CHARITY CARE IS ALSO AVAILABLE IN THE ADMISSION AREA OF THE CLINIC. |
| PART VI, LINE 4: | KMHC PRIMARILY SERVES THE RESIDENTS OF KITTSON COUNTY, WHICH IS LOCATED IN NORTHWEST MINNESOTA, WITH A POPULATION OF APPROXIMATELY 4,500. THIS IS A VERY RURAL AREA WITH 4.1 PERSONS PER SQUARE MILE. THE MEDIAN HOUSEHOLD INCOME IS $52,304 WITH 6.4% OF THE POPULATION BELOW POVERTY LEVELS. |
| PART VI, LINE 5: | KITTSON MANAGERS DELIVER COMMUNITY MEALS ON WHEELS FOR ONE MONTH EACH YEAR; SUPPORT A VIRTUAL "RELAY FOR LIFE" EVENT; PROVIDE AMBULANCE STAND-BY SERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS; PROVIDE FREE BLOOD PRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDE FINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS' "AFTER PROM PARTY" EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LAB TESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE; HEALTH INFORMATION BOOTH AT FOUR DAY COUNTY FAIR. KITTSON HEALTHCARE ALSO PROVIDES SERVICES THAT OTHER PRIVATE ENTITITES TYPICALLY WON'T CONSIDER PROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, ELDERLY WAIVERED SERVICES, COMMUNITY FITNESS, AMBULANCE SERVICES, ETC. AS THERE IS LITTLE VOLUME AND MINIMAL FINANCIAL RETURN. HOWEVER, KITTSON HEALTHCARE'S GOVERNING BOARD VIEWS THESE SERVICES AS ESSENTIAL IN MEETING THE NEEDS AND SERVING THE RESIDENTS OF KITTSON COUNTY. |
| PART VI, LINE 6: | N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | EDUCATIONAL ASSISTANCE | GrantTypeTxt |
| Recipient | 2 | RecipientCnt |
| Cash Grant | $6,116 | CashGrantAmt |
| Non Cash Assistance | SCHOLARSHIP FUNDS ARE GENERALLY PAID DIRECTLY TO FINANCIAL INSTITUTIONS.IN THE EVENT THAT A STUDENT PAYS SOMETHING AND REQUESTS REIMBURSEMENT, THEINDIVIDUAL IS REIMBURSED UPON SUBMISSION OF AN INVOICE FOR EXPENSES PAID. | NonCashAssistanceDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAUL ANDERSON THROUGH 318 | ||||||||||||||
| PHYSICIANS ASSISTANT | $117,576 | $0 | $0 | $0 | $36,500 | $0 | $14,556 | $0 | $0 | $0 | $168,632 | $0 | $0 | $0 |
| THOMAS LOHSTRETER THROUGH 418 | ||||||||||||||
| MEDICAL DOCTOR | $347,549 | $0 | $0 | $0 | $75,700 | $0 | $10,318 | $0 | $0 | $0 | $433,567 | $0 | $0 | $0 |
| JAMES SURDY | ||||||||||||||
| MEDICAL DOCTOR | $385,506 | $0 | $0 | $0 | $37,200 | $0 | $14,394 | $0 | $0 | $0 | $437,100 | $0 | $0 | $0 |
| KAREN WARNER | ||||||||||||||
| PHYSICIANS ASSISTANT | $117,825 | $0 | $0 | $0 | $37,200 | $0 | $1,600 | $0 | $0 | $0 | $156,625 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE (COMPRISED OF THE BOARD OFFICERS) CAN ACT ON BEHALF OF THE FULL BOARD IN CERTAIN CIRCUMSTANCES. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE METHOD USED FOR THE MEMBERS TO ADOPT, AMEND OR REPEAL THE EXISTING BYLAWS CHANGED FROM AT LEAST 50 MEMBERS WITH VOTING RIGHTS TO AT LEAST 20. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP IN THE ASSOCIATION SHALL BE ANY NATURAL PERSON OF LEGAL AGE PURCHASING ONE OR MORE MEMBERSHIP SHARES OF THE CORPORATION FOR THE SUM OF $50.00 EACH. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS ARE ALLOWED TO VOTE FOR MEMBERS OF THE BOARD AT THE ANNUAL MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO REVIEWED THE PROPOSED FROM 990 AND PRESENTED TO THE GOVERNING BOARD OF DIRECTORS FOR THEIR APPROVAL. UPON APPROVAL BY THE GOVERNING BOARD, THE 990 WAS THEN FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE BOARD'S POLICY TO AVOID ANY POSSIBLE APPEARANCE OF IMPROPRIETY OR BREACH OF THE MEMBER'S FIDUCIARY RESPONSIBILITY BY HAVING BOARD MEMBERS ANNUALLY ACKNOWLEDGE ANY POTENTIAL BUSINESS OR PERSONAL CONFLICTS IN REGARDS TO KITTSON MEMORIAL'S BUSINESS AFFAIRS. IT IS NOT THE INTENTION OF THIS POLICY TO PRECLUDE A BOARD MEMBER FROM BEING INVOLVED IN THE DISCUSSION OF A SUBJECT WHERE THE BOARD MEMBER HAS A CONFLICT OF INTEREST. HOWEVER, DISCRETION SHOULD BE EXERCISED AND THE BOARD MEMBER IS EXPECTED TO ABSTAIN FROM VOTING ON THE MATTER. THE CONFLICT OF INTEREST POLICY IS SIGNED ANNUALLY AT THE BOARD'S REGULAR MEETING IN JANUARY. THIS STATEMENT IS RETAINED BY THE PRESIDENT AND A COPY FILED IN THE CEO'S OFFICE. THE PRESIDENT IS RESPONSIBLE TO CALL INTO QUESTION A POSSIBLE CONFLICT OF INTEREST OF A PARTICULAR BOARD MEMBER WHEN APPLICABLE IN THE EVENT THE BOARD MEMBER DOES NOT DECLARE A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS DETERMINED BY A MAJORITY VOTE OF THE BOARD OF DIRECTORS. THE GOVERNING BOARD REVIEWS SALARY SURVEY INFORMATION FROM THE MN HOSPITAL ASSOCAITION AND OFFERS COMPETITIVE WAGES BASED ON THE SURVEY. THE DOCUMENTATION OF SUCH DECISION IS RECORDED AND FILED ON THE EMPLOYEE'S HR FILE. OTHER OFFICERS' COMPENSATION IS DETERMINED BY THE CEO. THE CEO REVIEWS SALARY SURVEY INFOMRATION FROM THE MN HOSPTIAL ASSOCAITON AND OFFERS THE KEY EMPLOYEE'S COMPETITIVE WAGES BASED ON THE SURVEY. THE DOCUMENTATION OF SUCH DECISION IS RECORDED AND FILED ON THE EMPLOYEE'S HR FILE. COMPENSATION WAS LAST REVIEWED IN 2019. |
| FORM 990, PART VI, SECTION C, LINE 19 | KITTSON MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 1,658,277. MANAGEMENT AND GENERAL EXPENSES 227,790. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,886,067. |
| FORM 990, PART XI, LINE 9: | ENDOWMENT FROM DONOR, PERMANENTLY RESTRICTED FOR NURSING SCHOLARSHIP 50,312. |
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